| NPI | 1104440866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: RI MD21258) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 284239) |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2026-05-11 |